| Myrtle Ridge Family Medicine, Pa | |
|
1539 Dale Mabry Hwy 102 Lutz FL 33548-3008 | |
| (813) 909-7102 | |
| (813) 909-0199 |
| Full Name | Myrtle Ridge Family Medicine, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1539 Dale Mabry Hwy, Lutz, Florida |
| Authorized Official Name and Position | Jack Bergh (CEO) |
| Authorized Official Contact | 8139097102 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Myrtle Ridge Family Medicine, Pa Po Box 660 Lutz FL 33548-0660 Ph: (813) 909-7102 | Myrtle Ridge Family Medicine, Pa 1539 Dale Mabry Hwy 102 Lutz FL 33548-3008 Ph: (813) 909-7102 |
| NPI Number | 1427195809 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 01/10/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427195809 | NPI | - | NPPES |
| 770008300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0056971 (Florida) | Primary |
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